CPT code 27060 is the code used for the surgical removal of the ischial bursa, a fluid-filled sac near the hip.
CPT code 27060 is the procedure for the removal of the ischial bursa, which is a small fluid-filled sac located near the ischium bone in the pelvis. This procedure typically involves excising the bursa to alleviate pain or discomfort caused by inflammation or other conditions affecting the area.
When billing for the CPT code 27060 (Removal of ischial bursa), several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used:
1. -50: Bilateral Procedure
- Use this modifier if the procedure is performed on both sides of the body.
2. -RT: Right Side
- Use this modifier to indicate that the procedure was performed on the right side of the body.
3. -LT: Left Side
- Use this modifier to indicate that the procedure was performed on the left side of the body.
4. -59: Distinct Procedural Service
- Use this modifier when the procedure is performed separately from other procedures on the same day, indicating that it is not part of a bundled service.
5. -76: Repeat Procedure by Same Physician
- Use this modifier if the procedure is repeated by the same physician on the same day.
6. -78: Unplanned Return to the Operating/Procedure Room by the Same Physician
- Use this modifier if the patient requires a return to the operating room for a related procedure within the global period.
7. -79: Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if a different procedure is performed by the same physician during the postoperative period of the original procedure.
8. -22: Increased Procedural Services
- Use this modifier if the procedure required significantly more work than typically required, justifying additional reimbursement.
9. -52: Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
10. -53: Discontinued Procedure
- Use this modifier if the procedure was started but discontinued due to extenuating circumstances.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines provided by the payer to ensure accurate billing and reimbursement.
The CPT code 27060 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. To determine if CPT code 27060 is reimbursed under the Medicare Physician Fee Schedule (MPFS), healthcare providers should consult the MPFS database. This database provides detailed information on the payment rates for services covered by Medicare.
Additionally, it is essential to check with the relevant Medicare Administrative Contractor (MAC) for your region. MACs are private health care insurers that have been awarded a geographic jurisdiction to process Medicare Part A and Part B medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries. Each MAC may have specific guidelines and local coverage determinations (LCDs) that can affect the reimbursement of CPT code 27060.
Therefore, while CPT code 27060 is generally reimbursed by Medicare, the exact reimbursement details should be verified through the MPFS and the appropriate MAC for your area.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level and by individual payer. With RevFind, you can identify discrepancies for CPT code 27060 and ensure you are receiving the payments you deserve. Schedule a demo today to see how RevFind can streamline your revenue recovery process.
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